Measuring Costs and Outcomes of Tele-Intervention When Serving Families of Children who are Deaf/Hard-of-Hearing

Identifying data elements and key features to design a telerehabilitation system for speech and language disorders in children with hearing impairments in Iran: A cross-sectional study

Background and Aims

Designing and implementing telerehabilitation systems would require the identification of data elements to meet disabled people's needs. An in-depth study on the identification and validation of data elements can help design and implement telerehabilitation systems successfully. Therefore, this study aimed to identify and validate data elements to design a telerehabilitation system for the speech and language disorders of hearing-impaired children in Iran.

Methods

This descriptive cross-sectional study was conducted in three steps including literature review, focused group discussion, and Delphi technique implementation to extract and validate data elements. In the first step, the literature on electronic databases was reviewed to extract the data elements of telerehabilitation systems, and nine studies were selected based on the inclusion criteria. In the second step, a focused group discussion was held to review and classify the extracted data elements. Finally, the Delphi technique was employed to validate the drafted data elements.

Results

In total, 352 data elements were extracted from the literature review. Finally, 102 data elements in 10 categories (Demographic and Clinical information of the disabled person, Clinical history, Demographic information of the provider, Customization of exercises, Reminders, Online and offline counseling, and training, Reporting, Key features of the system, Evaluation of the progress of the disabled person) were classified and validated by experts as essential data elements to design a telerehabilitation system for the speech and language disorders of hearing-impaired children.

Conclusions

The necessary data elements were proposed as the foundations to design a telerehabilitation system for the speech and language disorders of hearing-impaired children. These data elements help design and implement telerehabilitation systems successfully so that such systems can easily be provided for children with hearing disabilities.

Comparing the Clinical Effectiveness of Telerehabilitation with Traditional Speech and Language Rehabilitation in Children with Hearing Disabilities: A Systematic Review

Introduction: The use of telerehabilitation for the treatment of speech and language disorders in the field of hearing is increasing. A comprehensive study comparing telerehabilitation's effectiveness with traditional rehabilitation can help us understand it better. Therefore, this systematic review aimed to compare the effectiveness of telerehabilitation with traditional rehabilitation for speech and language disorders in children with hearing disabilities in 2023. Methods: A systematic search was conducted in PubMed, PubMed Central, Cochrane, Scopus, Google Scholar, Science Direct, and the Web of Science from 2000 to February 28, 2023. The articles were selected based on keywords, determined criteria, and reviewed in terms of title, abstract, and full text. Finally, articles that were relevant to our aim were evaluated. Results: The initial search resulted in the extraction of 1,788 articles. After reviewing the articles and applying the inclusion and exclusion criteria, nine articles were selected for analysis. Four (44.44%) and 3 (33.33%) studies were case-control and quasi-experimental studies, respectively. Four (44.44%) studies were conducted in the United States. SPSS, Preschool Language Scales, fifth edition (PLS-5), and microphone were the most common tools, each of which included 4 (44.44%), 3 (33.33%), and (333.33%) studies. Conclusions: Traditional rehabilitation and telerehabilitation can effectively improve the speech and language skills of children with hearing disabilities. However, it is always suggested to use traditional rehabilitation first to achieve better results.

Evidence-Based Implementation of the Family-Centered Model and the Use of Tele-Intervention in Early Childhood Services: A Systematic Review

BACKGROUND

The purpose of this review is to explore the evidence and efficacy of two trends in early childhood intervention services: the family-centered model and the use of tele-intervention.

METHODS

A systematic review was carried out following the PRISMA methodology and using three databases: Web of Science, PubMed and Scopus. The studies included were those aimed at children from 0 to 6 years of age, focused on early intervention, and which alluded to the family-centered model and/or tele-intervention.

RESULTS

a total of 33 studies were included. Five main themes were identified: (1) The participation of children and family is facilitated and improved by the family-centered model of care; (2) the feeling of competence, self-efficacy, satisfaction and empowerment in professionals and families have a positive impact on quality of life; (3) the use of tele-intervention as a tool for prevention and intervention; (4) preparation for telepractice can improve the development of commitment; (5) tele-intervention as a possible solution to contextual barriers.

CONCLUSIONS

Tele-intervention in pediatrics is presented as a tool inherent to the family-centered model since its implementation involves several common strategies. Future lines of research should explore the use of this tool as a possible solution to contextual barriers.

Telehealth Delivery in Part C Early Intervention: Provider and Caregiver Perspectives

Telehealth is a promising modality for Part C early intervention (EI), services typically implemented face-to-face in home and community settings. Barriers to telehealth in EI reported prior to COVID-19 included lack of training and access to reliable internet. The abrupt telehealth shift at the onset of the pandemic did not permit a phased adoption approach. This mixed-methods study aimed to characterize perspectives of service changes resulting from the telehealth transition. Providers (n = 39) and caregivers (n = 11) completed surveys about perceptions towards the telehealth switch. All providers indicated at least one aspect of services had changed. Approximately half of caregivers reported satisfaction with services decreased and half that satisfaction remained the same. Implications for telehealth in EI beyond the pandemic are discussed.

Systems that support hearing families with deaf children: A scoping review

BACKGROUND

Over 90% of deaf children are born to hearing parents who have limited knowledge about deafness and require comprehensive support and information to support and communicate with their deaf child. However, little is known about the systems that support hearing families with deaf children. We performed a scoping review to provide an overview of current literature on the topic.

METHODS

The protocol of the scoping review was prepared using the PRISMA statement guidelines for scoping reviews. Relevant search terms were used to identify eligible studies following discussion with the study's steering group. Databases searched were CINAHL, Medline, ProQuest Central and ASSIA, as well as grey literature from relevant journals and online sources. Included were studies published from 2000 to 2021 and available in English.

RESULTS

A search of databases identified 1274 articles. After excluding duplicates, screening titles and abstracts and full texts, 65 papers matched the identified inclusion criteria. Results included 1 RCT, 7 comparative studies, 6 literature reviews, 4 PhD theses, and 47 further empirical studies.

CONCLUSION

There is limited quality evidence on what supports hearing parents with deaf children. It is evident that further studies are needed to ensure comprehensive support is accessible and effective for hearing parents of deaf children.

Delivery of School-based Physical Therapy via Telehealth: Perceptions and Attitudes of School-based Physical Therapists

AIMS

School-based physical therapists (SBPTs) rapidly transitioned to telehealth during the pandemic. This study explored the perceptions of, and strategies utilized by, SBPTs delivering therapy via telehealth.

METHODS

Using a grounded theory qualitative design, semi-structured interviews were completed with 13 SBPTs. Interviews were transcribed and theme coded until saturation was achieved.

RESULTS

The following themes emerged: supports and education, challenges, strategies promoting success, and the outcomes of telehealth. SBPTs overcame challenges including those associated with technology, communication, space, equipment, and examination. Coaching techniques, incorporation into the daily routine, and the sharing of demonstrations promoted success. Telehealth service delivery was perceived to improve communication with educational teams and families, improve efficiency and productivity, increase access to students, promote an appreciation of the family and home context, and enhance family engagement. SBPTs believe incorporating elements of telehealth in conjunction with in-person delivery is ideal.

CONCLUSIONS

While the COVID-19 pandemic forced a rapid transition to telehealth for SBPTs, lessons learned could have a long-lasting positive impact on school-based services. The benefits of telehealth should be considered in the delivery of school-based physical therapy services.

Families' and professionals' perspectives of building and maintaining engagement in telepractice early intervention for young children with communication disability

PURPOSE

To explore and describe families' and professionals' perspectives about building and maintaining engagement in telepractice early intervention (EI).

METHODS

Individual semi-structured reflexive interviews were conducted with Australian families of young children with communication disability receiving telepractice EI and their treating professionals. These interviews were conducted within one day of a telepractice EI session and analysed using thematic analysis.

RESULTS

Thematic analysis of 72 interviews resulted in five themes that emphasised collaboration as an overarching enabler of engagement. The themes were: (1) the delivery of family-centred telepractice was essential for engaging children and families; (2) engagement in telepractice was variable and was affected by child, parent and professional factors; (3) engagement was an investment that required time, consistency and technology; (4) maximising communication interactions during telepractice sessions encouraged children and families to engage with professionals; and (5) joint planning and preparation facilitated child and family engagement in telepractice.

CONCLUSIONS

In the midst of the current COVID-19 pandemic, the present study shed light that in many ways, engagement in in-person and telepractice intervention is similar. However, the findings revealed the importance of families having an active role in telepractice EI sessions that occur in the family's social and communication environment.Implications for RehabilitationFamily engagement and high levels of parent participation are recommended in family-centred early intervention (EI).In EI delivered via telepractice, families and professionals invest in engagement-building and collaboration in a similar manner to in-person EI and in line with the principles of family-centred practice.The distinctiveness of telepractice engagement includes professionals being conscious of their communication style, taking advantage of the home environment, communicating inside and outside appointments, and jointly planning with parents/primary carers.EI professionals and students who work with young children with communication disability via telepractice can benefit by considering the engagement-building strategies described in the present study.

Barriers and facilitators to paediatric caregivers' participation in virtual speech, language, and hearing services: A scoping review

Purpose

Virtual care-related technologies are transforming the way in which health services are delivered. A growing number of studies support the use of virtual care in the field of audiology and speech-language pathology; however, there remains a need to identify and understand what influences caregiver participation within the care that is virtual and family-focused. This review aimed to identify, synthesize, and summarize the literature around the reported barriers and facilitators to caregiver participation in virtual speech/hearing assessment and/or intervention appointments for their child.

Methods

A scoping review was conducted following the Joanna Briggs Institute manual for evidence synthesis. A search was conducted using six databases including MEDLINE, CINAHL, SCOPUS, ERIC, Nursing and Allied Health, and Web of Science to collect peer-reviewed studies of interest. Data was extracted according to a protocol published on Figshare, outlining a predefined data extraction form and search strategy.

Results

A variety of service delivery models and technology requirements were identified across the 48 included studies. Caregiver participation was found to vary across levels of attendance and involvement according to eight categories: Attitudes, child behavioral considerations, environment, opportunities, provider-family relationship, role in care process, support, and technology.

Conclusions

This review presents a description of the key categories reported to influence caregiver participation in virtual care appointments. Future research is needed to explore how the findings can be used within family-centered care models to provide strategic support benefiting the use and outcomes of virtual care.

The experiences of speech-language therapists providing telerehabilitation services to children with autism spectrum disorder

Background

There has been an increased emergence of the use of telerehabilitation by speech-language therapists (SLTs) in South Africa since the COVID-19 pandemic in 2020.

Objectives

To explore the criteria that SLTs use when recommending telerehabilitation for children with autism spectrum disorder (ASD), the technical skills required, strategies used by SLTs, the restrictions encountered when conducting telerehabilitation and the views of SLTs on telerehabilitation in comparison to face-to-face therapy for children with ASD.

Method

A descriptive, phenomenological, qualitative study design was utilised. Purposive and snowball sampling techniques were employed. Six SLTs from the private sector, who had experience providing telerehabilitation to children with ASD, were recruited from three provinces in South Africa. Data were gathered via semistructured online interviews and analysed using thematic analysis.

Results

Two out of five themes that emerged from this study are presented in this paper, i.e. approaches to telerehabilitation and the benefits of telerehabilitation. Results revealed that telerehabilitation was used to provide assessment and therapy during the COVID-19 pandemic lockdowns as an alternative method of service delivery. Assessment and treatment strategies included synchronous and asynchronous methods, family collaboration, social stories, frequent breaks and interactive sessions. Telerehabilitation reduced the client’s and SLT’s travel costs and increased caregiver and clinician satisfaction. Client progress and increased awareness of SLT were viewed as further benefits.

Conclusion

Telerehabilitation was found to be beneficial to most children with ASD, and in most cases, the benefits far outweighed the challenges encountered. Clinical implications included the need for caregiver support in facilitating effective carryover, an increase in SLTs’ knowledge and the opportunity to provide services to a broader geographical range. Limitations of the study are included.

A Qualitative Study Exploring Parental Perceptions of Telehealth in Early Intervention

Using telehealth as a mode of service delivery has the potential to address some long-standing challenges in early intervention (EI) services such as waiting lists to access services. Yet, little is known about parent perceptions of telehealth in EI based on their lived experiences partnering with EI practitioners. The purpose of this study was to explore parent perceptions on using telehealth, especially on family-professional partnerships and coaching. Interviews were conducted with 15 parents of children receiving EI services via telehealth from June to August of 2021. Almost half of the participants reflected under-represented racial and ethnic backgrounds. Constant comparative analysis and emergent coding were used for data analysis. The findings showed that the advantages outnumbered the disadvantages regarding telehealth. Participants reported that telehealth provided a safe and flexible option and eliminated the wait to access EI services. However, participants identified some disadvantages to telehealth including telehealth precluded substantive interactions with therapists and limited access to technology. The findings also indicated that telehealth enhanced family-professional partnerships. Nearly all participants valued coaching during telehealth. Participants suggested initial supports to facilitate EI via telehealth, including stable internet access, telehealth training, and an initial in-person visit. Implications for research and practice are discussed.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10882-022-09853-w.

Orientation and mobility for children with visual impairments during COVID-19: Responses from O&M professionals to a disruption of traditional services

After lockdowns and school closings associated with COVID-19 began throughout the United States and Canada in March 2020, this research was completed to explore how the pandemic affected access to orientation and mobility (O&M) services. Using qualititave responses from a mixed methodology study, this article reports the findings from 318 individuals, including both O&M specialists and dually certified teachers of students with visual impairments (TVIs) and O&M specialists. Four major themes emerged through data analysis, including (1) prioritization of O&M goals for students with visual impairments, (2) personal factors affecting access to O&M training, (3) access to O&M services through virtual learning, and (4) creative approaches to O&M instruction during the pandemic. Within these themes, professionals, students, and families alike were asked to assume roles that went beyond traditional expectations. Questions and concerns that professionals in the field need to consider when looking at the future of O&M services were raised as part of this research, including a number of ideas for future studies.

Effects of Early Intervention Frequency on Expressive Vocabulary Growth Rates of Very Young Children Who Are Deaf or Hard of Hearing: How Much Is Enough?

PURPOSE

The aims of this study were to explore expressive vocabulary growth rates of children who are deaf or hard of hearing (DHH) during critical periods of brain development (birth to 3 years) as well as the factors that influence the trajectories of vocabulary growth in these early years of development. Of primary interest was the effect of intervention frequency on expressive vocabulary growth.

METHOD

Hierarchical linear modeling was used to investigate trajectories of expressive vocabulary growth using multiple measures of longitudinal vocabulary scores. A total of 417 assessments across 105 participants were analyzed to determine the average rate of lexical growth in a young population of children who are DHH receiving early intervention before age 3 years. Expected growth trajectories were constructed based on varying frequencies of intervention during critical periods of brain development.

RESULTS

Results indicated average growth rates of 5.21 new words expressed per week. Increased intervention hours prior to age 3 years was significantly associated with higher degrees of expressive vocabulary growth.

CONCLUSION

The findings of this study suggest that greater intervention hours received before age 3 years are associated with higher degrees of expressive vocabulary growth for children who are DHH.

Aural Rehabilitation via Telepractice During COVID-19: A Global Perspective on Evolving Early Intervention Practices

INTRODUCTION

Pre-pandemic, telepractice was not globally implemented despite its effectiveness. Clinicians reported challenges related to technology, confidence, and inadequate resources.

OBJECTIVES

To document global telepractice, identify current obstacles and measure the impact of a possible solution. The timing of this research facilitated tracking telepractice changes during the pandemic.

METHODS

Two surveys measured practitioners' experience and attitude towards telepractice. Survey 1 was completed in February-March 2020. Participants then received two specialized lesson kits to trial if desired. Survey 2 was a follow-up after 4-6 weeks.

RESULTS

Between surveys, the proportion of participants providing telepractice increased from 47.6% to 91.7%. The lesson kits were trialled by 74.3%. Their use had a positive impact on three of the top five factors affecting the delivery of telepractice: parent coaching, clinician experience and accessing resources. Conclusion: Telepractice was rapidly adopted globally during the pandemic. The specialized resources were helpful in overcoming some of the barriers to delivery.

Practitioners' Self-Assessment of Family-Centered Practice in Telepractice Versus In-Person Early Intervention

For infants and young children who are identified as deaf or hard of hearing (DHH), best practice principles indicate the provision of family-centered early intervention (FCEI). However, factors such as geographical inaccessibility and workforce shortages can limit families' access to FCEI in their local area. One strategy for overcoming these barriers is telepractice-a method of connecting families and practitioners using synchronous, two-way audiovisual technologies. This study compared the self-assessed use of family-centered practices by a group of practitioners delivering FCEI through telepractice with that of a similar group delivering FCEI in-person. A sample of 38 practitioners (15 telepractice and 23 in-person) from two early intervention programs for children who are DHH completed a self-assessment tool: the Measures of Processes of Care for Service Providers. Results indicated that there were no significant differences between telepractice and in-person sessions with regard to practitioners' self-assessment of their use of family-centered practices.

Integrated Discourse Therapy After Glioblastoma: A Case Report of Face-To-Face and Tele-NeuroRehabilitation Treatment Delivery

Background: Language and communication impairments are among the most frequently reported long-term behavioral consequences of brain tumor. Such deficits may persist long after a patient has been discharged from the hospital and can significantly impact return to work, resumption of prior social roles, and interpersonal relations, as well as full engagement in leisure activities. While considerable research has centered on identifying and describing communication impairments in brain tumor survivors, relatively little research has investigated language therapy for this population.

Aims: This report (1) reviews the literature and describes the language and cognitive-communicative profile of a 35-year-old man 6 years post glioblastoma excision with subsequent chemo- and radiation therapies; (2) presents cognitive-communication outcome data for this individual following an integrated discourse therapy; and (3) assesses treatment feasibility in face-to-face (F2F) and tele-neurorehabilitation (TNR) contexts.

Methods: A battery of tests and weekly conversation probes were administered to evaluate baseline performance and potential changes associated with F2F and TNR treatment delivery. Integrated Conversation Therapy (ICT) was administered across four alternating (F2F and TNR) treatment blocks over 2 months. ICT is a solution-focused discourse intervention that simultaneously targets word finding, sentence processing, and authentic patient-selected conversational interactions.

Results: Although the participant presented with long term-language impairments that were clinically distinct from stroke-associated aphasia, statistically significant post-treatment gains (>2 SEM) were evident following F2F and TNR treatment delivery on standardized measures of apraxia, discourse production, verbal memory, and self-ratings of discourse production, communication, and living with aphasia. While objective measures of treatment effect size (probes of CIU discourse data) were consistent across F2F and TNR delivery models, results of a satisfaction survey indicated a slight but statistically significant participant preference for TNR treatment delivery.

Conclusions: This study provides preliminary support for F2F and TNR delivery of ICT discourse intervention for glioblastoma survivors. It also highlights the need for more research specifically dedicated to language therapy for this population.

An examination of clinical uptake factors for remote hearing aid support: a concept mapping study with audiologists

OBJECTIVE

To develop a conceptual framework around the factors that influence audiologists in the clinical uptake of remote follow-up hearing aid support services.

DESIGN

A purposive sample of 42 audiologists, stratified according to client-focus of either paediatric or adult, were recruited from professional associations in Ontario, Canada, as members of the six-step, participatory-based concept mapping process. Analyses included multidimensional scaling and hierarchical cluster analysis.

RESULTS

Six main themes emerged from this research according to overall level of importance: (1) technology and infrastructure; (2) audiologist-centred considerations; (3) hearing healthcare regulations; (4) client-centred considerations; (5) clinical implementation considerations; and (6) financial considerations. Subthemes were identified at the group-level and by subgroup. These highlight the importance of TECH factors (accessible Technology, Easy to use, robust Connection, and Help available), as well as the multi-faceted nature of the perceived attitudes/aptitudes across stakeholders.

CONCLUSION

Findings can be utilised in tailored planning and development efforts to support future research, knowledge dissemination, best-practice protocol/guideline development, and related training to assist in the clinical uptake of remote follow-up hearing aid support services, across variable practice contexts.

Exploring factors influencing the use of an eHealth intervention for families of children with hearing loss: An application of the COM-B model

BACKGROUND

Prior to developing a successful eHealth intervention, it is important that we explore stakeholders' capacity to adapt to eHealth.

OBJECTIVE

To explore what factors influence the use eHealth services from the perspectives of families of children with hearing loss and professionals who support families as they transition into early intervention.

METHODS

A qualitative study incorporating semi-structured in-depth interviews was conducted with families (n = 17) and professionals (n = 11). Interview topic guides were developed based on the COM-B model of behaviour change to explore barriers and facilitators related to capability, opportunity, and motivation.

RESULTS

The COM-B model captured several factors that may influence the use eHealth interventions for families of children with hearing loss. The capability factors included computer literacy and familiarity with social media. The opportunity factors were access to online resources, reliable Internet, and affordable equipment. Professionals' and families' preferences and a culture of face-to-face services were also identified as barriers for using eHealth. The motivation factors included families' and professionals' confidence in using technology and beliefs that there were benefits (e.g., saving travel) associated with using eHealth services. In contrast, beliefs that eHealth may be difficult to set up and not able to replace in-person communication identified as barriers to families and professionals adopting eHealth interventions.

CONCLUSION

Findings of this study indicated that implementation of an eHealth intervention could be facilitated by addressing the barriers in stakeholders' capabilities, opportunities (e.g., equipment and social support), and motivation (e.g., negative beliefs about eHealth) before developing eHealth services.

Comparison of Caregiver Engagement in Telepractice and In-person Family-Centered Early Intervention

Telepractice-specifically, the use of high-speed internet and interactive videoconferencing technology to deliver real-time audio and video communications between the family and the practitioner-is gaining acceptance as an alternative means of providing family-centered early intervention to families of children who are deaf and hard of hearing. This study examined whether caregivers' reported perceptions of self-efficacy and involvement differed when early intervention was delivered in-person and through telepractice. The Scale of Parental Involvement and Self-Efficacy (SPISE) was used to evaluate perceptions of two groups of caregivers: one that received early intervention in-person (n = 100) and a group who received services through telepractice (n = 41). Results indicated that mode of delivery of services was not related to caregivers' perceptions of their self-efficacy or involvement. Further analysis revealed that although certain caregiver or child characteristics did influence some aspects of caregivers' beliefs about their self-efficacy or involvement, the effect of those variables was similar across both modes of delivery.

Report on the Use of Telehealth in Early Intervention in Colorado: Strengths and Challenges with Telehealth as a Service Delivery Method

The use of telehealth as a service delivery method for early intervention (EI) is in its infancy and few studies have examined its use within the context of a statewide program. The focus of this report was to determine the factors that influence providers' utilization of telehealth in Colorado's Part C Early Intervention program (EI Colorado). This report presents information that was gathered through surveys sent to Part C program administrators, service coordinators, providers, and caregivers. Surveys were used to understand perceptions of telehealth, actual experiences with telehealth, and perceived benefits and challenges using this service delivery method. Follow-up focus groups were conducted with program administrators and family members to gather more nuanced information. Participants identified several benefits associated with telehealth including its flexibility, access to providers, and more family engagement. The primary barriers included access to high speed internet and the opinion that telehealth was not as effective as in-person treatment. The results in the report served to identify next steps in the implementation of telehealth in Colorado's Part C EI program.

Profound Hearing Loss: Addressing Barriers to Hearing Healthcare

The impact of profound hearing loss on infants and adults is variable and greatly influenced by improved audition derived from hearing aids and cochlear implants. However, barriers to healthcare, hearing healthcare in particular, can offset the benefits provided by these sensory devices. Common barriers include cost, location, availability of trained professionals, acceptance of the hearing loss, language and cultural differences, secondary disabilities, and mental health issues. These barriers and their distinct presentations vary somewhat by age, language, and where people live (urban vs. rural), and can interfere with receiving testing and devices in a timely manner. They also can limit auditory, speech and language therapies, and interfere with acceptance of the hearing loss and devices. Rehabilitation should focus on eliminating or reducing the adverse impact of these barriers on patients and their families. Some of which can be done through professional training and multidisciplinary activities, counseling, and community outreach.

The Promise of Prevention Science for Addressing Intergenerational Poverty

This paper reviews research suggesting that the prevention of intergenerational poverty will be enhanced if we add evidence-based family and school prevention programs to existing efforts to reduce poverty in order to address the adverse social environments that often accompany poverty. Government policies such as the Earned Income Tax Credit can reduce family poverty, but simply improving the economic stability of the family will not necessarily prevent the development of child and adolescent problems such as academic failure, antisocial behavior, drug abuse, and depression, all of which can undermine future economic wellbeing. We briefly review the evidence linking family poverty to adverse social environments, which can have deleterious effects on children's psychological, behavioral, neurological, and physical development. We then document the value of evidence-based family- and school-based prevention programs in effectively addressing these behavioral, emotional, cognitive, and neurophysiological factors that can put children at risk for continued poverty in adulthood. We also describe three family-based prevention programs that have been found to have a direct effect on families' future economic wellbeing. The evidence indicates that widely disseminating effective and efficient family- and school-based prevention programs can help to address both poverty itself and the effects of adverse social environments, making future poverty less likely. We conclude with specific recommendations for federal and state policymakers, researchers, and practitioners.

Telepractice delivery of family-centred early intervention for children who are deaf or hard of hearing: A scoping review

Introduction

The use of telepractice, a method of delivering services through telecommunications technologies that provides two-way, synchronous audio and video signals in real-time, is becoming increasingly commonplace in early childhood education and intervention for children who are deaf or hard of hearing. Although the use of telepractice has been validated in the health sector as a viable and effective alternative to in-person service provision, evidence to support its use in the delivery of family-centred early intervention is still emerging. The purpose of this scoping review was to describe the current use of telepractice in the delivery of family-centred early childhood intervention for children who are deaf or hard of hearing, and their families.

Method

The review followed the framework outlined by the Joanna Briggs Institute (2015), including an iterative three-step search strategy. Specific inclusion criteria and data extraction fields were outlined in advance.

Results

A total of 23 peer-reviewed publications were included in the review. Most publications (70%) provided anecdotal evidence of the challenges and benefits associated with telepractice. The remaining publications (30%) reported on research studies evaluating the effectiveness of early intervention delivered through telepractice. Of the 23 included papers, 18 viewed the use of telepractice positively while the remaining 5 reported mixed conclusions and the need for more data.

Discussion

Current evidence in the literature indicates that telepractice can be an effective model for delivering family-centred early intervention for children who are deaf or hard of hearing. However, more research is needed to substantiate the use of telepractice as a viable alternative to traditional in-person services, rather than being seen as supplemental to such services.

You're Deaf? Breaking through Myths for Effective Therapeutic Practice

Most mental health practitioners provide services to hearing clients and might be unprepared when a deaf individual requests services. The purpose of this article is to explore commonly held stereotypes and myths about deaf people and to provide guidance to clinicians who encounter deaf clients in their practices. Myths and stereotypes can affect the way clinicians perceive their clients' needs. This can lead to miscommunication, misunderstanding, and misinformation, which can harm the therapeutic relationship, thus making effective therapy unattainable. Clinicians should reframe these beliefs and overcome barriers to make way for the therapeutic process to begin.

Is Telemental Health Services a Viable Alternative to Traditional Psychotherapy for Deaf Individuals?

Access to mental health treatment is a vital part of a comprehensive health care plan. Deaf individuals often have difficulty accessing mental health services. Four-hundred twenty-two participants completed an anonymous questionnaire about their perspectives of telemental health services for deaf individuals. Results showed that several variables, such as if the participant was unable to receive another type of psychotherapy and whether the therapist was ASL-fluent, were significantly related to whether the respondent would use TMH. The participants reported that TMH services are a viable option for treating a variety of mental health issues. Telemental health services can act as a bridge between consumers of mental health care and their providers allowing accessible and equitable healthcare opportunities.

Tele-intervention for children with hearing loss: A comparative pilot study

Introduction This pilot study compared tele-intervention to conventional intervention for children with hearing loss in terms of communication performance, parental perceptions and clinician perceptions. Methods A within-subject design was employed, including 10 children with hearing loss and their parents who each received a structurally similar tele-intervention and conventional intervention session in a counterbalanced manner. Quality of communication performance was analysed using a modified Tait video analysis method. Parent and clinician perceptions were collected through rating-scale surveys and thematic analysis of qualitative responses. Results No significant difference ( p > 0.05) was found between tele-intervention and conventional intervention in terms of communication performance of children. Parent perceptions were not significantly different ( p > 0.05) between conventional and tele-intervention in terms of facilitating meaningful communication interaction. Significant differences were evident for parents' comfort level during the session, whether they found it to be a beneficial experience and whether they would like to continue receiving intervention through this method.  Clinician perceptions of conventional and tele-intervention were not significantly different ( p > 0.05) and tele-intervention was deemed a valuable method of service delivery for clients. Discussion This study provides preliminary evidence that tele-intervention is effective for communication intervention and can be a valuable solution to typical barriers such as distance and the shortage of trained interventionists.

Provider Perspectives on Telepractice for Serving Families of Children Who are Deaf or Hard of Hearing

Telepractice to deliver remote Part C early intervention (EI) services to families in their home is a rapidly-growing strategy under the Individuals with Disabilities Education Act (IDEA) to meet the needs of infants and toddlers who are deaf or hard of hearing. A survey was completed within a “learning community” comprised of staff from EI programs that were implementing telepractice to learn about their specific implementation strategies and challenges they faced. Twenty-seven individuals representing 11 programs responded. The results showed great variability in hardware and software, with many raising concerns regarding security. Primary challenges reported were internet connectivity and training in skills required to deliver telepractice services. The findings from this survey were valuable in guiding future areas of investigation for the learning community and ultimately improving telepractice in the field.

Stuttering intervention in three service delivery models (direct, hybrid, and telepractice): two case studies

This study assessed outcomes in stuttering intervention across three service delivery models: direct, hybrid, and telepractice for two 11-year old children who stutter. The goal of the study was to investigate whether short-term goals were maintained through the telepractice sessions. The Stuttering Severity Instrument, Fourth Edition (SSI-4) was administered to each child before and after each intervention period and weekly fluency samples (percentage of stuttered syllables in a monologue) were obtained in each of the 10-week intervention periods. In addition, the Communication Attitudes Test-Revised was used to assess the children's attitudes toward speaking. Following the telepractice period, parents and children completed a questionnaire concerning the therapy experience via telepractice. Both children continued to improve fluency as measured by the weekly fluency samples. SSI-4 severity ratings improved for one child and remained consistent for the other. These outcomes appear to demonstrate that telepractice is viable for improving and maintaining fluency.